#3: IHR/ICD

*****Article 12

Determination of a PHEIC

ICD classifies data under headings such as

Diagnosis, reason for admission, conditions treated, reason for consultation

ICD 11 is available and *six* official languages since its publication which are:

English, Arabic, French, Spanish, Russian, Chinese

Ontology concepts

Entity & quality

Subject areas affected by IHR implementation

Environment, public health, international ports airports ground crossings, customs, food safety, agriculture, radiation safety, chemical safety, transportation, collection using disclosure of public health information, public health activities of authorities

PHEIC definition

Extraordinary event, pH risk through international spread, require a coordinated international response

_______________ (_________) conceived the idea of classification of diseases and published it under the title __________________

Francois Bossier de Lacroix (1706-1777) Nosologia Methodica

Dx with gaming disorder If:

Have trouble controlling behaviour, only predominantly interested in gaming and continue gaming despite negative consequences

Key purposes and applications of ICD

Health management Reimbursement and resource allocation Epidemiology Clinical purposes

If vaccination is contra indicated on medical grounds:

Healthcare practitioner must provide person with documented reasons Authorities on arrival should take into account

Fundamental of a statistical classification of disease

Identify specific disease, statistical presentation of data Enable useful info to be obtained

Influenza A (H1N1, Swine Flu)

In March 2009, began spreading in Mexico Within 90 days became pandemic/global Northbound volume dropped 42% Southbound volume dropped 57%

Chapter 20 contains subdivision to:

Indicate the type of activity being undertaken at the time of the event

Chapter 19 contains subdivisions to:

Indicates open and close fractures as well as intracranial, intrathoracic, and intra-abdominal injuries with and without open wound

Article 1 definitions

Isolation and quarantine, standing and temporary recommendation

Middle East respiratory syndrome

Jordan: April 2012 11 pneumonia cases (8 healthcare workers) One patient: pneumonia and pericarditis other: pneumonia and Dic

What are the international health regulations

Legal instrument that covers measures for preventing the transnational spread of infectious disease *"To prevent protect against control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks and which avoid unnecessary interference with international traffic and trade"*

ICD-10-PCS codes contain _______ characters.

seven

The purpose of ICD is

To allow the systematic *recording, analysis, interpretation,* and *comparison of mortality and morbidity data* collected in different countries all areas and at different times

How many criteria are met for a Country to be required to notify WHO within 24 hours

Two of the four

Article 10

Verification

Arrangement of volumes of ICD 10

Volume one: main classifications Volume two: instruction/guidance to users Volume three: alphabetical index

Who is responsible for the cooperation in IHR?

WHO

History of IHR in 1969

WHO adopted international sanitary regulation and renamed it as IHR

Structure and principles of ICD were originally conceived by:

William Farr

Only disease for which proof of vaccination can be required for travellers as a condition of entry into a country

Yellow fever

Mandatory vaccination for travellers

Yellow fever (according to vaccination Country list) Meningococcal disease and polio (required by Saudi Arabia for pilgrims)

Key features of IHR 1969

1.notification of cases of cholera, plague, smallpox, and yellow fever 2.rules for international travel and trade 3.maximum border measures 4.health documents

Health measures at Port on departure

- If the area is declared as infected, the crew of the ship requires a valid certificate to that effect - The health Authority may examine any person before his departure on an international voyage - A crew on an international voyage if placed under surveillance may be allowed to continue voyage but must notify the place where he is proceeding

Four decision criteria are used to assess PH events

- Is the public health impact of this event potentially serious? - Is this event unusual or unexpected? - Is there potential for international spread? - Is there potential for travel and trade restrictions?

Priorities subjects areas

- National focal points: designation and operation - Detection, reporting, verification, and control of events - Implementation of documents: annex 3,6,8,9 -designation of ports of entry - Identification of ports authorised to issue ship sanitation certificates and provide related services

Health measures at ports on arrival

- Not to cause discomfort to any person or injury to health - Health Authority shall issue: 1) certificate free of charge of sanitary measures methods and reasons 2) certificate to any traveller of date of arrival/departure and measures applied -allow a person under surveillance to move freely - Ship shall not be denied of free pratique

New mandate and obligations in the IHR

- Notify a potentially wide range of events to WHO that may constitute a PHEIC - WHO is obliged to request verification of events - State parties are also obliged to inform WHO of significant evidence outside their territory - national IHR focal - WHO IHR contact point

*Screening of persons at entry and exit

- Review travel history in affected areas - Review medical examination - Require vaccination or other prophylaxis - Quarantining suspect persons - Isolate affected persons - Tracing contacts of suspects or affected - # refuse entry of suspects and affected persons - Refuse entry of unaffected persons to affected areas - Implement exit screening and or restrictions on persons from the affected areas

Main use of ICD

- Translate diagnoses to alphanumeric code - Has become the international standard *diagnostic classification* for all general epidemiological and many health management purposes - Suitable for studies of *financial aspects* of the health system

Classification of ICD is grouped as:

- epidemic diseases - Constitutional or general illness - Local diseases arranged by site - developmental diseases - injuries

Categories of reportable diseases

-Epidemic prone diseases -Foodborne diseases -Accidental and deliberate outbreaks -Toxic chemical accidents -Radio nuclear accidents -Environmental disasters

ICD-10-PCS coding structure: eg 0DB68ZX

0: section D: body system B: root operation 6: body part 8: approach Z: device X: qualifier

Limitations of HR in 1969

1. Concerns only cholera, plague, and yellow fever 2. Dependent on official notification from member state 3. No formal mechanisms for collaboration between member state and WHO

Objectives of IHR 2005

1. appropriate application of routine preventative measures 2. notification to WHO 3. implementation of temporary recommendations 4. provision of support

Article 3 principles:

1. implementations with full respect for dignity, human rights, and freedoms 2. guided by Charter of UN, and Constitution of WHO 3. guided by goal of universal application for protection of all people 4. In accordance with the principles of international law & UN Charter, states have the right to legislate to pursue health policies

Documents that must be checked or issued by health officer on visiting every vessel granted radio free pratique:

1. maritime declaration of health (if last port is a foreign port) #2. Crew list 3. Yellow fever vaccination certificates 4. Deratting or deratting exemption certificate #5. Medicine chest certificate 6. Certificate of health and sanitary inspection 7. Certificate showing date and time of granting radio pratique

Why do countries use ICD

1. to monitor epidemics/PH threats/disease burden 2. to assess progress 3. To define obligations of WHO 4. To facilitate access to appropriate healthcare services 5.as a basis for Guidelines 6.facilitates research

IHR 1969 vs 2005

1.from three diseases to all public health risks 2.from preset measures to tailored response 3.from control of borders to also include containment at source 4.from reactive to proactive

Country may require a traveller coming from an area with a risk for yellow fever transmission to be quarantined or placed under surveillance:

1.if the traveller is unable to produce a valid certificate of vaccination against yellow fever 2.until the certificate becomes valid 3. until a period of not more than six days

Why a new IHR?

1.increasing international travel and trade 2. Early warning is essential 3. Measures should be coordinated internationally 4. Recent experiences: anthrax attacks 2001, SARS 2003, and Chernobyl disaster

*Obligations of the member states under IHR 2005

1.national IHR focal point 2.strengthening core capacity 3. Assessing events that may constitute a PHEIC within 48 hours and notifying WHO within 24 hours of assessment 4. Routine inspection and control activities 5. Examining national laws, revising health documents/forms and certificates, and building legal and administrative framework

Purpose and scope of IHR

1.prevent, protect against and control the spread of disease 2.provide a public health response to the international spread of disease restricted to public health risks 3.avoid unnecessary interference with international traffic and trade

During the last five years WHO has verified more than ________ epidemic events worldwide

1100

Supplementary subdivisions are found in which chapters?

13, 19, 20

??????________ participants taking part in______code assignments

1673, 112383

WHO released a version of ICD 11 to allow member states time to plan implementation on:

18 June 2018

First world health assembly was held in

1948 * beginning of a new era in international vital and health statistics

ICD-6

1948, International classification of diseases, injuries, and causes of death

How many countries are involved in IHR

196 (ya3ni kol dowal el 3alam) All are members of the WHO

How many airline passengers travelled in 2006

2.1 billion

I HR implementation timeline

2005: adopted 2007: entered into force 2009: assessments complete 2009 to 2012: capacity building 2012: compliance achieved

ICD10 has _______ chapters vs _______ in ICD 9

21, 17

World health assembly adopted revised IHR IN?

23rd of May 2005

?????______ countries where involved in ICD 11 field testing

31

?????__________ codes in icd-11 vs _______ in icd-10

55000, 14400

International tourist arrivals in the year 2005 exceeded

800 million

WHO helpline consists of:

9 WHO Collaborating centres for classification of diseases

What block is cholera?

A00

What block is amoebiasis?

A06

Chapter 13 contains subdivisions by

Anatomical site

Maritime declaration of health

Annex 8

Health part of aircraft general declaration

Annex 9

Ship sanitation certificate

Annex3

International certificate of vaccination and prophylaxis

Annex6

Benefits of ICD 10

Better health care for patients

Chapter I of ICD 10 contains?

Blocks: (A00-B99) *Certain infections and parasitic disease* To axes of classification: 1) Mode of transmission 2) broad group of organisms

Chapter II of ICD 10 contains?

Blocks: (C00-D48) *Neoplasm* Axes: First: behaviour of neoplasm Within the first: by site

New dz added to ICD 11

Burnout, gaming disorder, compulsive sexual behaviour

Chapters of ICD 10 contain

Chapters 1 to 17: diseases and other morbid conditions Chapter 18: symptoms and signs Chapter 19: injuries and poisoning Chapter 20: external causes of morbidity and mortality is Chapter 21: factors influencing health status and contact with health services

Immunisations of Selective use for travellers

Cholera HAV Japanese encephalitis Tick - borne encephalitis Meningococcal dz Rabies Typhoid fever Yellow fever

Known epidemic prone diseases

Cholera Pneumonic plague Viral haemorrhagic fever Yellow fever West Nile fever Other locally or regionally important diseases (dengue fever)

Limitations of IHR in 1969 concern only

Cholera, plague, and yellow fever

ICD 10 PCS impact/benefit

Code standardised/provide additional specificity Ability to capture new medical advances in technology

Routine immunisation for travellers includes

DPT MMR HPV HBV H influenzae type b Influenza Pneumococcal dz Poliomyelitis Rotavirus Tuberculosis (BCG) Varicella

Definition of standing recommendation

Non-binding advice issued by WHO for *PH health risks* regarding appropriate health measures for *routine or periodic application*

Definition of temporary recommendation

Non-binding advice issued by WHO for application on a *time-limited, risk specific basis,* in response to a *PHEIC*

Article 14

Operation of WHO with intergovernmental organisations and international bodies

Article 9

Other reports

How many airline passengers are estimated to travel now

Over 3 billion

How many diseases are known now and were unknown a generation ago

Over 40

Article 11

Provision of information by WHO

The mandate of the ICDis based on

Public health and clinical objectives Best evidence available today, health categories for public health reporting & clinical care Categories defined and operationalised

Article 13

Public health response

Where does the ICD fall under in the WHO family of International classifications?

Reference classifications

Definition of quarantine

Restriction of activities or separation from others of *suspected* person Who is not ill, to prevent *possible* spread of infection or contamination

Burn out.. results from? Characterised by?

Results from chronic stress, occupational phenomenon and is not considered a medical condition, characterised by (for dx): 1.feelings of energy depletion or *exhaustion* 2.increased *mental distance* from one's job of feelings of *negativism* or cynicism related to one's job 3.*reduced professional efficacy*

ICD 10 coding: S42.321A.. each one represents?

S42: category (core code) *first character is alpha except U 3: etiology 2: location 1: laterality/severity A: extension (for obstetrics, injuries, and external causes of injuries)

Four diseases always need to be reported to WHO

SARS Smallpox New influenza viri Wild-type polio

Definition of isolation

Separation of ill or contaminated person, to prevent the spread of infection or contamination

10th revision of the ICD started in

September 1983

SARS outbreak in China in 2002/2003 met which two criteria of assessment of PHEIC?

Serious impact of public health Potential for international spread

ICD includes

Signs and symptoms, abnormal findings, complaints and social factors

Unusual diseases

Smallpox Human Influenza (new subtype) Wild poliovirus SARS

Primer in ICD 11 speak

Terminology Ontology Semantic wiki Linearisation Content model Use-case